Assessing and Treating the Sensory Needs of Adults with Autistic Spectrum Disorder

Transcription

1 Assessing and Treating the Sensory Needs of Adults with Autistic Spectrum Disorder Heather Clarke-Lewis Lead Occupational Therapist Sensory Integration Practitioner 2 nd November 2017

2 Contents What is sensory processing and sensory dysfunction? The importance of assessing an individual s sensory needs Case study- from assessment to treatment Questions 2

3 Sight Visual system Interprets visual light to build up a representation of the world outside of the body Balance Vestibular system Maintains balance and provides input about orientation in space Touch Tactile system Responsible for sense of touch Smell Olfactory system responsible for sense of smell SENSES Taste Gustatory system Uses taste buds to provide information about the food eaten Body Awareness Proprioceptive System The position of the body/body parts in space Sound Auditory system Responsible for sense of hearing 3

4 What is sensory processing? 4

5 Arousal OPTIMUM 5

6 Sensory dysfunction 6

7 Sensory dysfunction 7

8 Sensory dysfunction 8

9 9 Why do you think it is critical to assess the sensory needs of the individuals we work with?

10 Importance of sensory assessment Awareness of the world around us Keeps us alert Allows us to alter our behaviour Keeps us safe- sensing danger/survival Emotion regulation/wellbeing Communication- understanding and responding Gives us a sense of where we are General functioning on a day to day basis- all ADLs Provides feedback on our performance Organises our behaviour Helps us to look after basic needs (hunger, warmth etc) Learning and development Assists with future planning/transition/discharge from hospital 10

11 Sensory Motor Perceptual Motor Cognition Auditory Language Skills Eye-hand co-ordination Body Scheme Daily Living Activities Academic Learning Visual Spatial Perception Ocular Motor Control Reflex Maturity Behaviour Intellect Attention Centre Functions Postural Adjustment Ability to Screen Input Development Development Sensory Postural Security Awareness of Two Sides of Body Motor Planning Olfactory Visual Auditory Gustatory Systems Tactile Vestibular Proprioception CENTRAL NERVOUS SYSTEM 11

12 Case study Bob Age: 25 (Pseudonym) 12

13 Introduction Diagnosis: Autistic Spectrum Disorder, Severe Learning Disability Communicates non-verbally, has a small repertoire of signing which he has developed for meeting basic needs (e.g. drink, chocolate) Lived in a large number of residential specialist school provisions throughout childhood Admitted to the Woodhouse Hospital in October 2011 Due to the frequency and severity of challenging behaviour, and his difficulties in coping with others, he has been living in longterm segregation for a number of years. 13

14 Outcome Measure- March 2017 Process Skills Affect/ Feelings/ Mood Communication/ Interaction Skills Self-esteem Life Skills Motivation Balanced Lifestyle Role Performance 14

15 Case Study Assessments Completed Dunn s sensory profile Sensory preferences tool History/childhood development information gained from meetings with family Clinical observations Review of behaviour recording (ABC charts) Questionnaires completed with key staff members, family and previous placements Attendance to all clinical meetings 15

16 Tactile Ritualistic behaviours Touching/holding objects Resisting/seeking touch Difficulty tolerating clothing Dislike wet/sloppy food textures- strong preference for dry foods Seeks pressure- squeezing self/pulling clothing over his head Low response to temperature and pain Self-injurious behaviour 16

17 Visual Notices small changes in his environment Looks at minute particles Picks up small pieces of fluff Attracted to lights Moves fingers/objects in front of his eyes Fascination with reflection/bright coloured objects Studies finer details of objects rather than the whole object Can appear startled if approached suddenly Hits/rubs own eyes when distressed 17

18 Auditory Frustration within crowded/noisy environments Banging objects/doors Makes loud rhythmic sounds Delayed responses to instructions/sounds 18

19 Olfactory- Smell Smells self/people/objects Occasionally smears faeces and is fascinated with the smell Hits nose when distressed Incontinent within own environment and whilst travelling in vehicle 19

20 Vestibular/Proprioception Rocking back and forth Altered muscle tone Difficulty in co-ordinating complex movements Spinning/jumping especially when frustrated or bored Walking on tiptoes Often in a constant state of motion 20

21 Assessment Conclusion Hyposensitive: The channel is not open enough; as a result too little of the stimulation gets in and the brain is deprived. Hypersensitive: The channel is too open; as a result too much stimulation gets in for the brain to handle. Visual Tactile Vestibular Proprioception Tactile Vestibular Proprioception 21

22 Current Intervention Sensory Diet A personalised activity plan which will provide Bob with the sensory input he requires in order to adaptively interact with the environment and remain in a calm-alert state A sensory diet is similar to a nutritional diet, where meals and snacks are provided throughout the day to keep our body functioning to their optimum. 22

23 Visual intervention ideas Play catch with slow moving objects e.g. balloons String blinking lights around his room Use Makaton as well as speech when communicating Provide a projector to increase visual interest Auditory intervention ideas Offer him a noisy activity; singing, music Put music/tv Go outside- listens to natural, outdoor sounds- birds singing, point out noises Introduction to white noise or other calming sounds Avoid raising voice Try to introduce hearing protection if showing distress (muffs, headphones, ear plugs) Shut the doors and windows to reduce external sounds Check for any other buzzing radiators/fans that might be annoying Bob 23

24 Tactile experiences Textured cloths/shower gels for washing Vibrations- toothbrush, cushions, massagers, mattress Weighted products- such as blanket/lap pad/vest Encourage walking barefoot in the grass Squeeze balls Textured flooring Textured items to hold in the hand Tight fitted clothing i.e. stretchy lycra Massage Proprioception/vestibular input Stretching/bending/twisting/rotational movements Push-pull activities that involve resistance (mopping/sweeping) Therapy ball/space hopper- bouncing on, rolling over the top Swings/trampoline 24

25 Findings so far Staff feedback: Increased ability to attend for longer periods and focus on tasks More accepting of new staff members Increased access to community venues, spending longer amount of time in vehicle, visiting family Observational assessment Using timeline communication aid to request activities, make choices and structure daily routine Further findings: Significant reductions in challenging behaviour (Approximately per week, however significant periods with no challenging behaviour) Utilising communal spaces within the unit: long-term segregation has ended. Future planning- a new house has been sought in the community. Sensory recommendations are informing a lot of the future planning- OT involvement 25

26 Outcome Measure- October 2017 Process Skills Affect/ Feelings/ Mood Communication/ Interaction Skills Self-esteem Life Skills Motivation Balanced Lifestyle Role Performance 26

27 Key points It is thought that over 98% of individuals with Autism, also have difficulties processing sensory information A full sensory assessment provides us with a greater wealth of information 1 in 6 of the worlds population have sensory processing difficulties Sensory strategies can help everyone, now and in the future 27

28 28 QUESTIONS